Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II-IV chronic kidney disease

Bacchetta, Justine; Boutroy, Stéphanie; Vilayphiou, Nicolas; Juillard, Laurent; Guebre-Egziabher, Fitsum; Rognant, Nicolas; Sornay‐Rendu, Elisabeth; Szulc, Paweł; Laville, Maurice; Delmas, Pierre D.; Fouque, Denis; Chapurlat, Roland

doi:10.1359/jbmr.090831

Cited by 94 publications

(67 citation statements)

References 40 publications

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“…When patients with a history of fracture were excluded, bone microarchitecture of CKD stages 2 to 4 patients was found to resemble the values of controls with normal and osteopenic aBMD. Compared with these data, the bone microarchitecture of the cohort of dialysis patients reported here resembles values reported from HR-pQCT measurements in osteoporotic patients (19). Duration of dialysis, age, previous kidney transplantations, and the presence of a fracture exerted the strongest influence on bone loss.…”

Section: Discussionsupporting

confidence: 67%

“…Because all patients in the study presented here had end-stage renal disease, the duration of CKD was considerably longer and the discriminatory power of HR-pQCT and DXA therefore accordingly better. A second study reported on HR-pQCT measurements in patients with stage 2 to 4 kidney disease in comparison to controls with normal kidney function (19). When patients with a history of fracture were excluded, bone microarchitecture of CKD stages 2 to 4 patients was found to resemble the values of controls with normal and osteopenic aBMD.…”

Section: Discussionmentioning

confidence: 99%

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Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Cejka

Patsch²,

Weber³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT).Design, setting, participants, & measurements Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined.Results Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. ConclusionsBone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Cejka

Patsch²,

Weber³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…There are few studies with which to compare our microarchitectural findings. Bacchetta et al 18 compared HR-pQCT of the radius and tibia in white patients with CKD with healthy matched control subjects. The 13 patients with fractures (traumatic and fragility combined) had significantly lower total vBMD, CtTh, and TbN at both radius and tibia.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Bacchetta et al 18 used high-resolution peripheral quantitative computed tomography (HR-pQCT; voxel size 82 m) to demonstrate that both cortical and trabecular microarchitecture are abnormal in patients with early CKD compared with healthy control subjects. In addition, they reported thinner cortices and abnormal trabecular microarchitecture in a small number of patients with CKD and with fractures; however, they did not measure aBMD by DXA.…”

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confidence: 99%

Bone Mass and Microarchitecture in CKD Patients with Fracture

Nickolas¹,

Stein²,

Cohen³

et al. 2010

Journal of the American Society of Nephrology

160

118

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Patients with predialysis chronic kidney disease (CKD) have increased risk for fracture, but the structural mechanisms underlying this increased skeletal fragility are unknown. We measured areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry at the spine, hip, and radius, and we measured volumetric BMD (vBMD), geometry, and microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius and tibia in patients with CKD: 32 with fracture and 59 without fracture. Patients with fracture had lower aBMD at the spine, total hip, femoral neck, and the ultradistal radius, the last having the strongest association with fracture. By HR-pQCT of the radius, patients with fracture had lower cortical area and thickness, total and trabecular vBMD, and trabecular number and greater trabecular separation and network heterogeneity. At the tibia, patients with fracture had significantly lower cortical area, thickness, and total and cortical density. Total vBMD at both radius and tibia most strongly associated with fracture. By receiver operator characteristic curve analysis, patients with longer duration of CKD had area under the curve of Ͼ0.75 for aBMD at both hip sites and the ultradistal radius, vBMD and geometry at the radius and tibia, and microarchitecture at the tibia. In summary, patients with predialysis CKD and fractures have lower aBMD by dual-energy x-ray absorptiometry and lower vBMD, thinner cortices, and trabecular loss by HR-pQCT. These density and structural differences may underlie the increased susceptibility to fracture among patients with CKD. Fracture rates in patients with ESRD are elevated, 1 as high as individuals who have normal kidney function and are older by 10 to 20 years. 2 Recently, there has been increasing recognition that patients with predialysis chronic kidney disease (CKD) also experience an increased fracture burden. [2][3][4][5] In 2006, we reported that participants who were older than 50 years in the Third National Health and Nutrition Examination Survey (NHANES III) and had an estimated GFR (eGFR) between 15 and 59 ml/ min (stages 3 and 4 CKD) had a two-fold higher risk for hip fracture than individuals without CKD. 6 Subsequent studies confirmed our findings and also demonstrated that fracture risk increases as kidney function declines. [3][4][5] In one study, hip fracture risk was as high in patients with stage 4 CKD as in patients with ESRD. 4 Given the rapid expansion of the population of individuals who are older than 65 years worldwide and the high prevalence of CKD in the elderly, 7 it is highly important to improve our understanding of the structural and biologic mechanisms that contribute to increased fracture rates in patients with CKD so that we can develop strategies to identify those who are at risk for fracture.In patients with ESRD, relationships between areal

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“…Interassay CV varied from 4.4 to 14.2% for concentrations between 4.3 and 9.7 nmol/l. Serum calcium, phosphorus, and creatinine were measured by standard laboratory methods (17). Glomerular filtration rate was estimated using the MDRD equation (18).…”

Section: Bone Turnover Markersmentioning

confidence: 99%

Association of bone microarchitecture with parathyroid hormone concentration and calcium intake in men: the STRAMBO study

Chaitou

Boutroy²,

Vilayphiou³

et al. 2011

European Journal of Endocrinology

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Objective: In the elderly, vitamin D deficit, low calcium intake, and impaired bone microarchitecture are associated with higher risk of hip fracture. We assessed the association of bone microarchitecture with calcium intake and serum concentrations of 25-hydroxycholecalciferol (25OHD) and parathyroid hormone (PTH) in men. Design: Cross-sectional analysis was performed in 1064 men aged 20-87 years not taking vitamin D or calcium supplements. Methods: Daily calcium intake was assessed using a food frequency questionnaire. Bone microarchitecture was assessed at distal radius and tibia by high-resolution peripheral quantitative computed tomography. We measured serum and urinary levels of biochemical bone turnover markers (BTMs). Statistical models were adjusted for age, weight, height, and glomerular filtration rate. Results: In 500 men aged !65 years, lower 25OHD levels and low calcium intake were associated with lower trabecular volumetric bone mineral density (Dtrab) at the distal tibia, due to lower trabecular number (Tb.N). Low calcium intake was associated with lower cortical thickness (Ct.Th). Higher PTH level was associated with higher BTM levels. In 563 men aged R65 years, the highest PTH quartile was associated with lower Ct.Th (tibia), lower Dtrab (both sites), and lower Tb.N (radius) compared with the lowest quartile. Low calcium intake was associated with lower Tb.N and more heterogenous trabecular distribution. BTM positively correlated with the PTH concentration. Conclusion: In older men, elevated PTH concentration is associated with high bone turnover, poor trabecular microarchitecture (radius and tibia), and, at the distal tibia, lower Ct.Th. Low calcium intake is associated with lower Tb.N and more heterogenous trabecular distribution.European Journal of Endocrinology 165 151-159

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Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II-IV chronic kidney disease

Cited by 94 publications

References 40 publications

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Bone Mass and Microarchitecture in CKD Patients with Fracture

Association of bone microarchitecture with parathyroid hormone concentration and calcium intake in men: the STRAMBO study

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